Long Term Effects

The first and most obvious danger of heroin use is addiction. Addiction is a life-changing, progressive disease. The average heroin addict spends between $120 and $200 per day to maintain a heroin addiction. Even if the physical damage of heroin abuse were not devastating, the lifestyle changes that an addict has to undertake to keep up his or her habit are ruinous as well. Addicts steal, sell possessions, and prostitute themselves to get enough money to support their habits.

Overdose

A person who is overdosing on heroin displays abnormal mental status, dramatically slowed breathing, and tightly constricted ("pinpoint") pupils. Most overdoses occur at home in the company of others. Overdoses are more common when alcohol and other drugs are also present.

In the hospital, overdose patients need "airway management," which means they need a breathing tube to keep their airway open, and they need intravenous medication to reverse the heroin’s effects. Patients can suffer pulmonary edema (lung swelling,) pneumonia, and other complications.

Overdoses are frighteningly common. A 1998 study in Australia revealed these statistics:

48% of regular heroin users had experienced at least one non-fatal overdose their life-time (median: two overdoses.)

11 % of regular heroin users had overdosed in the previous 6 months.

70% had been present at someone else's overdose at some time (median: three overdoses).

At the time of their own most recent overdose, 52% had been using central nervous system depressants in addition to heroin (benzodiazepines - 33% and/or alcohol - 22%.)

81% of overdoses occurred in a private home.

88% of overdoses in the presence of other people.

Despite 50% of heroin abusers understanding that half of regular heroin users would overdose during their lifetime, 73% of those surveyed said they "rarely" or "never" worried about possibly overdosing.

People taking heroin for the first time can die from sheer overdose or from allergic reaction to heroin or the additives in it. However, each year about one percent of all experienced heroin addicts in the United States die from an overdose of heroin despite their enormously increased tolerance to the effects of the drug. In a person who does not normally use heroin, the estimated deadly dose of heroin may range from 200 to 500 mg, but addicts have tolerated doses as high as 1800 mg without even being sick.

There are various explanations for the fact that it is relatively common for experienced addicts to have "overdoses" in spite of their huge tolerances: (1) Some addicts simply push their tolerance too far and take a truly massive amount at once. However, this is rare among experienced users. (2) An addict may unknowingly purchase heroin that is much more pure than what he is used to and take his normal dose anyway. (e) The additives in the heroin may produce unforeseen toxic effects. (4) The addict may take heroin together with alcohol, sedatives, or other drugs. Or, (5) The person may suffer a sudden loss of tolerance.

"Sudden loss of tolerance" was the subject of one recent study. The rats in the study were given daily intravenous injections for 30 days, either of a placebo or of heroin. The injections were given in either the animal colony or a different room where there was a constant white noise. The drug and the placebo were given on alternate days. A control group of rats received only the placebo. For any one heroin-receiving rat, the heroin was always given in the same setting, either the colony or the white noise room. For other rats the heroin was always given in the colony and the placebo was always given in the white noise room.

At the end of the 30 day introduction period, all of the rats were given a large dose of heroin. The rats in one group were given the heroin in the same room where they had previously been given heroin. (This was labeled the ST group.) The other rats, the DT group, were given the heroin in the room where they had previously been given the placebo. Ninety-six percent of the control group (who had never received heroin before) died, showing the lethal effect of the heroin in nontolerant animals. Rats in the DT group who received heroin were partially tolerant, and only 64 percent died. Only 32 percent of ST rats died, showing that the tolerance was even greater when the overdose test was done in the same environment where the drug previously had been administered.

The study suggests that one reason addicts suddenly lose their tolerance could be because they take the drug in a different or unusual environment like the rats in the DT group. Surveys of heroin addicts admitted to hospitals suffering from heroin overdose tend to support this conclusion.